Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program
Objective:. This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes among patients undergoing elective colorectal surgery. Background:. ERPs improve outcomes for surgical patients. While pre...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2024-06-01
|
| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000432 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832589697047592960 |
|---|---|
| author | Bayley A. Jones, MD Joshua Richman, MD, PhD Michael Rubyan, PhD, MPH Lauren Wood, MSPH Alfonsus Adrian H. Harsono, MD, MSPH Wendelyn Oslock, MD, MBA Nathan English, MBChB Burkely P. Smith, MD Robert Hollis, MD, MSPH Larry R. Hearld, PhD Isabel Scarinci, PhD, MPH Daniel I. Chu, MD, MSPH |
| author_facet | Bayley A. Jones, MD Joshua Richman, MD, PhD Michael Rubyan, PhD, MPH Lauren Wood, MSPH Alfonsus Adrian H. Harsono, MD, MSPH Wendelyn Oslock, MD, MBA Nathan English, MBChB Burkely P. Smith, MD Robert Hollis, MD, MSPH Larry R. Hearld, PhD Isabel Scarinci, PhD, MPH Daniel I. Chu, MD, MSPH |
| author_sort | Bayley A. Jones, MD |
| collection | DOAJ |
| description | Objective:. This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes among patients undergoing elective colorectal surgery.
Background:. ERPs improve outcomes for surgical patients. While preoperative education is an essential component of ERPs, its relationship with other components is unclear.
Methods:. This was a retrospective cohort study of all ERP patients undergoing elective colorectal surgery from 2019 to 2022. Our institutional ERP database was linked with American College of Surgeons National Surgical Quality Improvement Program data and stratified by adherence to preoperative education. Primary outcomes included adherence to individual ERP components and secondary outcomes included high-level ERP adherence (>70% of components), length of stay (LOS), readmissions, and 30-day complications.
Results:. A total of 997 patients were included. The mean (SD) age was 56.5 (15.8) years, 686 (57.3%) were female, and 717 (71.9%) were white. On adjusted analysis, patients who received preoperative education (n = 877, 88%) had higher adherence rates for the following ERP components: no prolonged fasting (estimate = +19.6%; P < 0.001), preoperative blocks (+8.0%; P = 0.02), preoperative multimodal analgesia (+18.0%; P < 0.001), early regular diet (+15.9%; P < 0.001), and postoperative multimodal analgesia (+6.4%; P < 0.001). High-level ERP adherence was 13.4% higher (P < 0.01) and LOS was 2.0 days shorter (P < 0.001) for those who received preoperative education. Classification and regression tree analysis identified preoperative education as the first-level predictor for adherence to early regular diet, the second-level predictor for LOS, and the third-level predictor for ERP high-level adherence.
Conclusion:. Preoperative education is associated with adherence to ERP components and improved surgical outcomes. |
| format | Article |
| id | doaj-art-5502d0ec8a324e6b88c9bfef1ebeb4dc |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2024-06-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-5502d0ec8a324e6b88c9bfef1ebeb4dc2025-01-24T09:18:39ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932024-06-0152e43210.1097/AS9.0000000000000432202406000-00037Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery ProgramBayley A. Jones, MD0Joshua Richman, MD, PhD1Michael Rubyan, PhD, MPH2Lauren Wood, MSPH3Alfonsus Adrian H. Harsono, MD, MSPH4Wendelyn Oslock, MD, MBA5Nathan English, MBChB6Burkely P. Smith, MD7Robert Hollis, MD, MSPH8Larry R. Hearld, PhD9Isabel Scarinci, PhD, MPH10Daniel I. Chu, MD, MSPH11From the * Department of Surgery, University of Alabama at Birmingham, Birmingham, ALFrom the * Department of Surgery, University of Alabama at Birmingham, Birmingham, AL† Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MIFrom the * Department of Surgery, University of Alabama at Birmingham, Birmingham, ALFrom the * Department of Surgery, University of Alabama at Birmingham, Birmingham, ALFrom the * Department of Surgery, University of Alabama at Birmingham, Birmingham, AL‖ Department of Surgery, University of Cape Town, Cape Town, South AfricaFrom the * Department of Surgery, University of Alabama at Birmingham, Birmingham, ALFrom the * Department of Surgery, University of Alabama at Birmingham, Birmingham, AL¶ Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL.‡ Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, ALFrom the * Department of Surgery, University of Alabama at Birmingham, Birmingham, ALObjective:. This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes among patients undergoing elective colorectal surgery. Background:. ERPs improve outcomes for surgical patients. While preoperative education is an essential component of ERPs, its relationship with other components is unclear. Methods:. This was a retrospective cohort study of all ERP patients undergoing elective colorectal surgery from 2019 to 2022. Our institutional ERP database was linked with American College of Surgeons National Surgical Quality Improvement Program data and stratified by adherence to preoperative education. Primary outcomes included adherence to individual ERP components and secondary outcomes included high-level ERP adherence (>70% of components), length of stay (LOS), readmissions, and 30-day complications. Results:. A total of 997 patients were included. The mean (SD) age was 56.5 (15.8) years, 686 (57.3%) were female, and 717 (71.9%) were white. On adjusted analysis, patients who received preoperative education (n = 877, 88%) had higher adherence rates for the following ERP components: no prolonged fasting (estimate = +19.6%; P < 0.001), preoperative blocks (+8.0%; P = 0.02), preoperative multimodal analgesia (+18.0%; P < 0.001), early regular diet (+15.9%; P < 0.001), and postoperative multimodal analgesia (+6.4%; P < 0.001). High-level ERP adherence was 13.4% higher (P < 0.01) and LOS was 2.0 days shorter (P < 0.001) for those who received preoperative education. Classification and regression tree analysis identified preoperative education as the first-level predictor for adherence to early regular diet, the second-level predictor for LOS, and the third-level predictor for ERP high-level adherence. Conclusion:. Preoperative education is associated with adherence to ERP components and improved surgical outcomes.http://journals.lww.com/10.1097/AS9.0000000000000432 |
| spellingShingle | Bayley A. Jones, MD Joshua Richman, MD, PhD Michael Rubyan, PhD, MPH Lauren Wood, MSPH Alfonsus Adrian H. Harsono, MD, MSPH Wendelyn Oslock, MD, MBA Nathan English, MBChB Burkely P. Smith, MD Robert Hollis, MD, MSPH Larry R. Hearld, PhD Isabel Scarinci, PhD, MPH Daniel I. Chu, MD, MSPH Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program Annals of Surgery Open |
| title | Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program |
| title_full | Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program |
| title_fullStr | Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program |
| title_full_unstemmed | Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program |
| title_short | Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program |
| title_sort | preoperative education is associated with adherence to downstream components and outcomes in a colorectal surgery enhanced recovery program |
| url | http://journals.lww.com/10.1097/AS9.0000000000000432 |
| work_keys_str_mv | AT bayleyajonesmd preoperativeeducationisassociatedwithadherencetodownstreamcomponentsandoutcomesinacolorectalsurgeryenhancedrecoveryprogram AT joshuarichmanmdphd preoperativeeducationisassociatedwithadherencetodownstreamcomponentsandoutcomesinacolorectalsurgeryenhancedrecoveryprogram AT michaelrubyanphdmph preoperativeeducationisassociatedwithadherencetodownstreamcomponentsandoutcomesinacolorectalsurgeryenhancedrecoveryprogram AT laurenwoodmsph preoperativeeducationisassociatedwithadherencetodownstreamcomponentsandoutcomesinacolorectalsurgeryenhancedrecoveryprogram AT alfonsusadrianhharsonomdmsph preoperativeeducationisassociatedwithadherencetodownstreamcomponentsandoutcomesinacolorectalsurgeryenhancedrecoveryprogram AT wendelynoslockmdmba preoperativeeducationisassociatedwithadherencetodownstreamcomponentsandoutcomesinacolorectalsurgeryenhancedrecoveryprogram AT nathanenglishmbchb preoperativeeducationisassociatedwithadherencetodownstreamcomponentsandoutcomesinacolorectalsurgeryenhancedrecoveryprogram AT burkelypsmithmd preoperativeeducationisassociatedwithadherencetodownstreamcomponentsandoutcomesinacolorectalsurgeryenhancedrecoveryprogram AT roberthollismdmsph preoperativeeducationisassociatedwithadherencetodownstreamcomponentsandoutcomesinacolorectalsurgeryenhancedrecoveryprogram AT larryrhearldphd preoperativeeducationisassociatedwithadherencetodownstreamcomponentsandoutcomesinacolorectalsurgeryenhancedrecoveryprogram AT isabelscarinciphdmph preoperativeeducationisassociatedwithadherencetodownstreamcomponentsandoutcomesinacolorectalsurgeryenhancedrecoveryprogram AT danielichumdmsph preoperativeeducationisassociatedwithadherencetodownstreamcomponentsandoutcomesinacolorectalsurgeryenhancedrecoveryprogram |